PPE Funding for Medi-Cal

$40 million to stabilize the Medi-Cal Dental network by reimbursing the costs of new PPE 

Aligns with both Senate and Assembly budget blueprints in committing to addressing health inequities exacerbated by the pandemic and to protect those who have been most impacted by COVID-19.

Background

At the beginning of the COVID-19 pandemic, approximately 97% of dental offices closed completely or were only seeing emergency patients from March through May 2020. Since dental practices reopened, they have continued to have significantly increased overhead costs combined with decreased patient volume due to COVID-19 safety guidelines and lingering public hesitation around receiving health care treatment. The high cost of personal protective equipment (PPE) has been exacerbated by ongoing product scarcity and supply chain disruptions. While many California dentists have been able to take advantage of federal relief programs such as PPP loans and CARES Act Provider Relief Funds, these funds fall far short of covering the economic losses and ongoing increased costs of safely treating patients during this ongoing pandemic.

State investments in the Medi-Cal program over recent years, including restoration of adult benefits, the Dental Transformation Initiative, Proposition 56 rate increases and administrative improvements, have made it a more sustainable program for dentists and resulted in significant increases in utilization of dental services. Over 1,900 dental providers throughout the state have newly enrolled to treat Medi-Cal beneficiaries, reversing a decade-long downward trend and opening access to hundreds of thousands of Medi-Cal beneficiaries.

The state must help ensure that the Medi-Cal dental program continues to improve and that the oral health of beneficiaries is not put at further risk because of the COVID-19 pandemic. With the increased economic burden of safely operating in the current circumstances, there is a risk of providers being unable to continue participating in the Medi-Cal Dental program due to unfunded costs, which could mean a constriction of the Medi-Cal Dental network and patients losing access to care.

How This Would Work

This proposal would allocate a one-time appropriation of $40 million GF ($80 million TF) to reimburse Medi-Cal Dental providers for the pandemic-related costs of new, mandatory, medically necessary infection control. The Department of Health Care Services would implement by activating a reimbursement code in the fee-for-service dental delivery system for which providers may receive reimbursement for PPE.

Budget Bill Language

4260-118-0001 — For local assistance, the State Department of Health Care Services ..........................................40,000,000

Provision:
1. The distribution of funds appropriated in this item shall be administered by the State Department of Health Care Services, in consultation with the California Dental Association, and shall provide a supplemental payment to active Medi-Cal dental providers for the costs associated with COVID-19 and personal protective equipment. These supplemental payments shall be applied to claims for services rendered between July 1, 2021, and June 30, 2022.

These allocations shall be implemented only to the extent that federal financial participation is not otherwise jeopardized.

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Paid for by the California Dental Association
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